一位皮肌炎併呼吸衰竭病童之加護經驗

本文主要探討一位1.5歲男童，因幼年型皮肌炎合併呼吸衰竭之照護經驗。護理期間自2019年8月16日至9月24日，藉由Gordon十一項健康功能型態進行整體性評估，確認個案有低效性呼吸型態、營養少於身體所需、身體活動功能障礙及照顧者角色緊張之護理問題。照護過程中規劃合適個案的遊戲治療，而順利移除氣管內管，藉由個案喜愛玩具及遊戲，參與護理活動，提升肺部及肢體的復健；並安排口腔復健、教導案母準備食物，增加營養攝取；而幼年型皮肌炎復發率相當高，此時主要照顧者扮演重要角色，故先減輕案母的經濟問題及焦慮，使案母可安心學習照護技巧，讓個案可順利返家照顧；而此時期的幼兒，難以表達心裡所需，故建議發展簡易版圖卡或工具，協助治療。

關鍵字

幼年型皮肌炎；呼吸衰竭；身體活動功能障礙

並列摘要

This article focuses on the nursing experience of a 1.5-year-old boy who became susceptible to infection and muscle weakness due to juvenile dermatomyositis, which caused respiratory failure. During the nursing period from August 16th to September 24th, 2019, Gordon's eleven functional health patterns were used to conduct a holistic assessment. The following nursing care problems were found including ineffective breathing pattern, inadequate nutritional balance, and impaired physical mobility and caregiver role strain. During the caring process, appropriate play therapy was planned for the patient so that the case could smoothly have the endotracheal tube removed. Through the patient's love of toys and games, participation in nursing activities improved rehabilitation of the lungs and limbs while oral rehabilitation was also arranged. Family members were taught to prepare proper foods to meet standard nutrition needs. The recurrence rate of juvenile dermatomyositis is quite high, and the primary caregiver plays an important role at this time, and in lightening the mother's burden of medical expenses and lowering their anxiety level, the caregiver was encouraged to participate in the caring program thereby increasing her confidence and relieving her strain when caring for the client at home. It is difficult for children in this period to express their needs, so it is recommended that simple layout cards or tools be developed to assist in treatment.

並列關鍵字

juvenile dermatomyositis ； respiratory failure ； impaired physical mobility

參考文獻

吳紋綺、廖顯宗（2019）‧多發性肌炎和皮肌炎的診斷及治療‧臨床醫學，83（3），174-183。https://doi.org/ 10.6666/ClinMed.201903_83(3).0030

張綺紋、姜月桃、余幸宜（2017）‧兒童治療性遊戲臨床運用之探討‧源遠護理，11（1），44-51。https://doi.org/10.6530/YYN/2017.5.4

劉詩玉、謝佳容（2018）‧不同身體質量指數之重症病人其營養支持狀況與臨床結果‧台灣營養學會雜誌， 42（4），111-120。https://doi.org/10.6691/NSJ.201812_42(4).0001

Almeida, B., Baker, M., Eleftheriou, D., & Al-Obaidi, M. (2015). Juvenile dermatomyositis. Paediatrics and Child Health, 25(12), 567-573. https://doi.org/10.1016/j.paed.2015.08.001.

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